Adrenaline, whether is it given according to the CPR recommendations, depending on the CPR duration length?

INTRODUCTION: According to current recommendations for cardiopulmonary resuscitation (CPR) for OHCA we can distinguish two kinds of rhythms: shockable (VF / VT) and non shockable (asystole / PEA). Drug that is used in both kinds of rhythms is adrenaline, except that with shockable rhythms it is used after the third defibrillation (about 6 minutes after the beginning of CPR), and with non shockable rhythms it is used within the first two minutes and is repeated every 3-5 minutes. Also, the recommendations state that CPR should be performed as long as the shockable rhythm persist, or there is some of the reversible causes of OHCA which we can treat, and in the case of asystole lasting longer than 20 minutes should be decided about the termination of CPR. MATERIAL AND METHODOLOGY: By retrospective analysis we got materials from the register of Emergency Medical Services Sombor in one year period starting from January 1st 2014 until January 1st 2015. RESULTS: During the observed period, our Service has had 63 OHCA when CPR was performed and those cases could be statistically analyzed. From those, shockable rhythms as the initial rhythm were in 21 cases or in 33.3%, and non shocable rhythms in 42 cases or in 66.7%. The average arrival time at the location was 5 minutes and 44 seconds, in case of shockable rhythms 4 minutes and 51 seconds, and in case of non shocable rhythms 6 minutes and 3 seconds. Average duration of CPR was 27 minutes and 12 seconds, as for the shockable rhythms 23 minutes and 45 seconds, and for non shocable rhythms 28 minutes and 56 seconds. In total was given 210 ampoules of adrenaline, with average of 3.33 ampoules of adrenaline per one CPR. Depending on the initial rhythm, for shockable rhythms was given an average of 2.05 ampoules of adrenaline (every 11 minutes and 35 seconds), and for non shocable rhythms 3.98 ampoules of adrenaline (every 7 minutes and 12 seconds). CONCLUSION: If by the use of adrenaline can be assessed whether the teams of our Services work under the recommendations and if this small sample can be considered statistically significant (percentage of the patients with established circulation (ROSC) 34.9%), we must be realistic and admit that we do not apply recommendations enough, and that the strict application of recommendations would bring even better results and greater survival rate

Continuous monitoring of out-of-hospital cardiac arrest in municipality Sombor - EuReCa_Srbija

Aims: Epidemiological follow up of out-of-hospital cardiac arrest (OHCA) in Municipality Sombor in period of 1st of January 2016 until 1st of June 2017. With focus on OHCA quality management. METODOLOGIJA: The project EuReCa is a part of a metacentric, observational, prospective study of an observational trail of the European Resuscitation Council registered Clinical Trial NCT02236819 and approved by the US healthcare authorities. The EuReCa_Srbija project is conducted by the Serbian Resuscitation Council, based on collaboration with the European Resuscitation Council with support of the Section of Emergency Medicine - Serbian Physicians Society. The data's from the Serbian cardiac arrest registry has been collected and analyzed via www.eureca.rs application. Results: Emergency medical service (EMS) in Sombor covers 85.900 citizens. In observed period 119 (138,5/100.000) OHCA's were registered. Cardiopulmonary resuscitation (CPR) was applied 94 (109,4/100.000) cases. Gender distribution shows that 58 OHCA occurred in male and 36 in female population. The most common etiological cause of OHCA had cardiac background in 61 (71/100.000) patinets. Home is the most common place where OHCA occurred in 69 cases with incidence 80,3/100.000). Witness was present 61 OHCA (71/100.000), and lay-person CPR was performed in 19 (22/100.000) patients until the arrival of the EMS. TeleCPR by the dispatcher was registered in 14 (16,2/100.000) cases. The initial shockable rhythm (pulseless ventricular tachycardia pVT /ventricular fibrillation VF) was observed in 30 (34,9/100.000) patients, and nonshockable rhythm (asistoly/ PEA) in 64 (74,5/100.000). Automated external defibrillator (AED) was never used. Return of spontaneous circulation (ROSC) was achieved in 51 (59,3/100.000) cases. At circadian ROSC distributionROSC was most commonly achieved in period between 6-14 hours. Hospital OHCA discharge survival was 6 (6,9/100.000), and the 30-days survival rate is 4 (4,6/100.000). Conclusion: By observing the epidemiological parameters of the OHCA, quality management related points were highlighted. The analyzed data's points to the fact that there is a higher incidence of almost all parameters included in the study protocol compared to previous period. Further observation and analysis will contribute to overall deeper insight of each observed segment that contributed to better and improved outcome with aim to continue the trend of positivity

EuReCa Serbia One 2014 - Research Center Sombor: Research results for October 2014. and comparative analysis with results for Republic of Serbia

INTRODUCTION: The most common cause of the out of hospital cardiac arrest (OHCA) is heart disease and then we are talking about sudden cardiac death (SCD), which is manifested by the loss of consciousness within one hour from the begining of the acute changes in the function of the cardiovascular system. Epidemiological data of OHCA in Europe are insufficient, while in Serbia do not exist. From 2014. Resuscitation Council of Serbia provides an opportunity for independent participation of the numeruous environments within EuReCa One Serbia 2014 in order to improve this situation. Data collecting was conducted in the period from 1st until 31st October 2014. with monthly tracking of the survival of the patients with return of spontaneous circulation (ROSC). AIM: With the comparative analysis of the obtained data via EuReCa One questionnaires show epidemiological differences of OHCA from our research center in relation to the summary results for the Republic if Serbia. MATERIALS AND METHODS: The prospective study, collecting data through questionnaires related to patients with cardiac arrest during the month of October 2014 in all research centers in the Republic of Serbia, and than comparative analysis of data obtained in the research center of Sombor with summary data from all research centers in Serbia. RESULTS: Incidence of the OHCA in Serbia is almost five times higher than in the municipality of Sombor. Further analysis shows that in the municipality of Sombor, OHCA almost always happened in the presence of bystanders, that the resuscitation was always started and that bystanders were twice as likely to provide basic life support measures until the arrival of the rescue team. Establishing of the ROSC on the field is three times greater in the municipality of Sombor. Also in the municipality of Sombor is higher incidence of the victims that survived OHCA after 30 days than at the national level. The distribution according to etiological causes of the OHCA does not differ significantly from the republic, noting that in the municipality of Sombor most of the OHCA are as consequence of cardiovascular pathology. CONCLUSION: There is a big difference between countries as well as between regions within countries in terms of epidemiology of the OHCA. A small number of respondents, conditioned by time and space limitations in this project prevents from making any relevant conclusion. Because of everything said projects like EuReCa One further on need to provide a better understanding of OHCA and thus better management of this condition, both in our center and at all research centers in the Republic of Serbia

EURECA One 2014: ROSC analysis

INTRODUCTION Cardiac arrest survival rate after out of hospital cardiopulmonary resuscitations is pretty low and goes from 1,7% to 6,1%. The return of spontaneous circulation is the first step towards complete recovery of the patient after experiencing cardiac arrest. Predictors of sustainable ROSC include witnessing of collapse by laymen, initial heart rhythm, bystander initiation of CPR, early EMS engagement, early defibrillation and short duration of medical transport. AIM: It is to investigate the return of ROSC in regards to epidemiological and demographic characteristics, treatment and outcome (survival after a month) with shockable initial rhythm for a six-month sample. METHOD: Prospective observational study where data were gathered through particular questionnaire that concerned OHCA (out-of-hospital cardiac arrest) on the territory of Vojvodina during six month period (from October 1st 2104. until March 31st 2015.). The data that were used are registered in the data base of European programme EuReCA One 2014. RESULTS: 276 patients that have had OHCA on the territory of Vojvodina were analyzed - the incidence of 40,63 per 100 000. EMS conducted CPR in 51,16% (N=155, n=22,82/100 000), ROSC was established in 30,32% (N=47, n=6,92/100 000), and 30 days survival was documented in 9,03% of the cases (N=14, n=2,06/100 000). Shockable rhythm was initially recognized with 59,57% of the patients (N=28, n=4,10/100 000). CONCLUSION: Cardiopulmonary resuscitation sets the return of spontaneous circulation (ROSC) as its primary objective, which depends great deal on key factors affecting the course of CPR, and positive variables for CPR course are initial shockable rhythm, witnessing of cardiac arrest by layman or EMS, heart condition as the presumed cause, female gender and age under 80 years

Is there a need for prehospital fibrinolysis

Introduction: Acute coronary syndrome represents a group of several different clinical conditions, all caused by acute myocardial ischemia and/or necrosis. It includes: unstable angina pectoris, non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Being a part of the 'Vojvodina STEMI network' since 2014. Emergency Medical Service of Sombor provides early pre-hospital diagnostic, initial therapy and transport of STEMI patients (with constant monitoring of vital parameters) to the Institute of Cardiovascular Diseases of Vojvodina in Sremska Kamenica for primary percutaneous coronary intervention (pPCI). Object: The object of this paper is to analyze the possibility of providing prehospital thrombolytic therapy for STEMI patients transported to the ICVDV Sremska Kamenica, within current standard protocol. Methodology: For the purpose of this research, a retrospective analysis of the registry 'Time management protocol for STEMI patients' was made from January 1st, 2014 to December 31st, 2017. These time frames were examined: duration from the onset of pain to the established diagnosis, duration of transport to the Institute and overall duration time from the onset of pain to pPCI. Furthermore, patients were divided into four groups according to the time duration from the onset of pain to the established diagnosis: less than 1 hour, less than 2 hours, less than 3 hours and more than 3 hours. Results: 34, 18% of the analyzed patients were diagnosed as STEMI patients within one hour from the onset of pain, 36.71% within two hours, 10.13% within three hours and 18.99% needed more than three hours. For all of those that got their STEMI diagnosis within one, two and three hours, the average time was 71.47 minutes (1 hour and 11 minutes) and for those who got diagnosed after three hours that time was 318.13 minutes (5 hours and 18 minutes). Summarized average time from the onset of pain to the establishing of STEMI diagnosis was 194.80 minutes (3 hours and 14 minutes) for both groups. The average transportation time was 71.32 minutes (1 hour and 11 minutes), shortest being 47 minutes and the longest 88 minutes. For all those in the group that needed less than three hours for STEMI diagnosis, the average time from the onset of pain to the ICVDV was 158.08 minutes (2 hours and 38 minutes), and for those who needed more than 3 hours to get diagnosed the average time from the onset of pain to the ICVDV was 416.57minutes (6 hours and 56 minutes). The overall average time for all analyzed patients, from the onset of pain to the catheterization lab of the ICVDV was 295.13 minutes (4 hours and 55 minutes). Conclusion: Taking into account these results, it becomes reasonable to apply fibrinolytic therapy before transporting, keeping in mind at all times current standard protocols and safety precautions for possible fibrinolytic therapy contraindications. If transport of a STEMI patient to the PCI lab is not likely to happen within the first 120 min, because of some kind of technical disability or catheterization lab overload, and that patient is presented to the EMS within the first three hours from the beginning of pain, fibrinolytic therapy should be used in order to establish reperfusion and to buy some time until transport to the pPCI